This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients hospitalized with acute decompensated heart failure if they develop cardiorenal syndrome as defined by ain increase in serum creatine of or equal to ).3 mg per deciliter from baseline while demonstrations signs and symptoms of persistent congestion. The trial is randomized to stepped pharmacologic care verses ultrafiltration. The primary endpoint is a change in the bivariate endpoint assessment of weight and change in creatinine within 96 hours.